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Chinese Medical Journal Jul 2024Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for...
BACKGROUND
Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.
METHODS
A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson's correlation, multiple linear regression, and analyses of covariance.
RESULTS
All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.
CONCLUSIONS
The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.
PubMed: 38958034
DOI: 10.1097/CM9.0000000000003156 -
Ghana Medical Journal Dec 2023Idiopathic focal unilateral skull thinning is a rare finding. An explanation, such as trauma or disease, can often be found. However, in some cases, no explanation is...
UNLABELLED
Idiopathic focal unilateral skull thinning is a rare finding. An explanation, such as trauma or disease, can often be found. However, in some cases, no explanation is forthcoming, and thus, we must look further into their history for a possible cause. The case of a nine-year-old boy with a crescent-shaped unilateral parietal bone thinning and a history of ventouse-assisted birth is presented. The lesion matches a ventouse's typical location, shape, and size. Thus, with the support of one other reported similar case, we hypothesise this may be the origin. We present the case of a crescent-shaped lesion matching the imprint of a ventouse in a child with a concordant history. This finding is put in the context of similar reports in the literature, and we believe that this report provides further evidence of this obscure phenomenon.
FUNDING
None declared.
Topics: Humans; Male; Parietal Bone; Child; Diagnosis, Differential; Tomography, X-Ray Computed
PubMed: 38957854
DOI: 10.4314/gmj.v57i4.10 -
Ghana Medical Journal Dec 2023The Scimitar syndrome or pulmonary venolobar syndrome is a rare, complex and variable congenital anomaly of cardiopulmonary development characterised by an abnormal...
UNLABELLED
The Scimitar syndrome or pulmonary venolobar syndrome is a rare, complex and variable congenital anomaly of cardiopulmonary development characterised by an abnormal right-sided pulmonary venous drainage in the inferior vena cava, malformation of the right lung, abnormal arterial supply and sometimes cardiac malformations. These serious anomalies notwithstanding, their presentation is varied, ranging from asymptomatic to severe symptoms, particularly in the neonatal and early infantile period. Some symptomatic cases are misdiagnosed as recurrent lower respiratory tract infections or as heart failure, missing the underlying congenital anomaly. Considering associated serious complications such as pulmonary hypertension and a high mortality rate, accurate and timely diagnosis is mandatory. This requires a high index of suspicion, not only by clinicians but also by radiologists who encounter suggestive chest radiographs in asymptomatic children. Still, the classic radiological finding for which the condition is named is seen in only about 50% of all cases and only 10% in affected infants. We highlight this case to heighten clinicians' and radiologists' suspicions about Scimitar syndrome.
FUNDING
None declared.
Topics: Humans; Scimitar Syndrome; Infant; Male; Radiography, Thoracic; Female
PubMed: 38957849
DOI: 10.4314/gmj.v57i4.9 -
Ghana Medical Journal Dec 2023To determine the angiographic severity of coronary artery disease (CAD) and assess the influence of major cardiovascular risk factors (CVRF).
OBJECTIVE
To determine the angiographic severity of coronary artery disease (CAD) and assess the influence of major cardiovascular risk factors (CVRF).
STUDY DESIGN
a cross-sectional, hospital-based study.
SETTING
the catheterisation laboratory of the National Cardiothoracic Centre, Accra, Ghana.
PARTICIPANTS
for 12 months, consecutive patients admitted for coronary angiography were assessed for the presence of CVRFs. Those with significant CAD after angiography were recruited into the study.
INTERVENTION
The patient's angiograms were analysed, and the CAD severity was obtained using the SYNTAX scoring criteria.
MAIN OUTCOME MEASURE
The lesion overall severity (SYNTAX) score and the relationship with CVRFs present.
RESULTS
out of the 169 patients that had coronary angiography, 78 had significant CAD. The mean SYNTAX score was 20.18 (SD= 10.68), with a significantly higher value in dyslipidaemic patients (p < 0.001). Pearson's correlation between the score and BMI was weak (r= 0.256, p= 0.034). The occurrence of high SYNTAX score lesions in about 18% of the population was significantly associated with hypertension (OR= 1.304, 95% CI [1.13-1.50]; p= 0.017) dyslipidaemia (OR= 5.636, 95% CI [1.17-27.23]; p= 0.019), and obesity (OR= 3.960, 95% CI [1.18-13.34]; p= 0.021). However, after adjusting for confounding factors, only dyslipidaemia significantly influenced its occurrence (aOR= 5.256, 95% CI [1.03-26.96]; p= 0.047).
CONCLUSION
Even though the most severe form of CAD was found in about one-fifth of the study population, its occurrence was strongly influenced by the presence of dyslipidaemia.
FUNDING
None.
Topics: Humans; Coronary Artery Disease; Male; Female; Cross-Sectional Studies; Coronary Angiography; Middle Aged; Severity of Illness Index; Heart Disease Risk Factors; Aged; Hypertension; Dyslipidemias; Ghana; Adult; Risk Factors
PubMed: 38957846
DOI: 10.4314/gmj.v57i4.2 -
Cureus Apr 2024Unilateral hypertrophy of the Tensor Fasciae Latae (TFL) muscle is a rare condition often characterized by a palpable mass in the lower limbs or hip pain. Despite its...
Unilateral hypertrophy of the Tensor Fasciae Latae (TFL) muscle is a rare condition often characterized by a palpable mass in the lower limbs or hip pain. Despite its rarity, several causative factors have been identified, necessitating accurate diagnosis and appropriate management. Here, we present the case of a 53-year-old patient who sought outpatient consultation for a mass in the anterolateral aspect of the right thigh. Through this case study, we aim to contribute to the limited literature on this condition by discussing our diagnostic approach, management plan, and outcomes. Upon presentation, the patient underwent a thorough physical examination, revealing a non-tender, sessile mass seemingly originating in the deep connective tissue of the thigh. A magnetic resonance image (MRI) was performed to confirm the diagnosis and assess the extent of muscle involvement. This noninvasive modality provided valuable insights into the nature and localization of the mass, providing the diagnosis and guiding subsequent management decisions. Given the benign nature of the condition and absence of associated symptoms, conservative management was favored. Physical therapy focusing on stretching and strengthening exercises was initiated to address the underlying probable causes and improve functional capacity. Close monitoring through regular follow-up appointments was also recommended to track the progression of the hypertrophy and ensure symptomatic relief. Unilateral hypertrophy of the TFL muscle is a rare entity that presents diagnostic and management challenges. Through our case study, we have highlighted the importance of a comprehensive diagnostic workup, including imaging studies, in confirming the diagnosis and guiding management decisions. Conservative approaches, such as physical therapy, can effectively manage symptoms and improve quality of life in affected individuals. Continued research and documentation of cases are essential to expand our understanding of this condition and refine treatment strategies.
PubMed: 38957828
DOI: 10.7759/cureus.58547 -
Cureus Apr 2024Metastatic cervical carcinoma from an unknown primary source poses a diagnostic and therapeutic challenge, as it involves the spread of cancer to the neck lymph nodes...
Metastatic cervical carcinoma from an unknown primary source poses a diagnostic and therapeutic challenge, as it involves the spread of cancer to the neck lymph nodes without a discernible primary tumor despite thorough investigation. While the diagnosis and treatment of this uncommon condition lack definitive evidence, a review of existing literature offers some clinical guidance. A comprehensive diagnostic evaluation, which includes multiple imaging and endoscopic studies, is essential. Surgery is preferred whenever feasible due to its ability to offer more precise staging. This treatment entails an excisional biopsy, neck dissection, and tonsillectomy, but advanced cases necessitate a combination of treatments. This case report underscores this complexity, where, despite radical neck dissection on the affected side, recurrence manifested after two months with no discernible primary site. We emphasize the urgency for continued research and innovative approaches to enhance the diagnosis and management of metastatic cervical carcinoma from an unknown primary source.
PubMed: 38957817
DOI: 10.7759/cureus.58537 -
Orthopedic Reviews 2024The diagnosis of periprosthetic joint infections (PJI) presents a formidable challenge to orthopaedic surgeons due to its complex and diverse manifestations. Accurate...
The diagnosis of periprosthetic joint infections (PJI) presents a formidable challenge to orthopaedic surgeons due to its complex and diverse manifestations. Accurate diagnosis is of utmost importance, as even mild pain following joint replacement surgery may indicate PJI in the absence of a definitive gold standard diagnostic test. Numerous diagnostic modalities have been suggested in the literature, and international societies have continually updated diagnostic criteria for this debilitating complication. This review article aims to comprehensively examine the latest evidence-based approaches for diagnosing PJI. Through a thorough analysis of current literature, we explore promising diagnostic strategies that have demonstrated effectiveness in identifying PJI. These strategies encompass the utilization of laboratory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), alongside imaging techniques such as magnetic resonance imaging (MRI) and leukocyte scintigraphy. Additionally, we highlight the importance of synovial fluid analysis, including the potential role of alpha-defensin as a biomarker, and examine evolving international diagnostic criteria to standardize and improve diagnostic accuracy.
PubMed: 38957745
DOI: 10.52965/001c.120308 -
Ghana Medical Journal Sep 2023To determine the clinical presentation, imaging features and outcomes of children with adenoid hypertrophy in our setting.
OBJECTIVES
To determine the clinical presentation, imaging features and outcomes of children with adenoid hypertrophy in our setting.
DESIGN
A retrospective study.
SETTING
The paediatric clinic of a private hospital in Enugu.
PARTICIPANTS
51 children, aged 2 to 108 months, with suggestive clinical features and radiographic report of adenoid hypertrophy who presented over 3 years.
INTERVENTIONS
Clinical information was obtained from the patient's medical records. Data was analysed for the clinical characteristics of the patients, the relationship between the degree of airway narrowing on a postnasal space (PNS) radiograph and treatment outcomes.
MAIN OUTCOME MEASURES
Degree of airway narrowing as measured on a PNS radiograph, the type of and outcomes of treatment.
RESULTS
There was an almost equal male (54.7%): female (45.1%) ratio in the occurrence of adenoid hypertrophy, with a mean age of occurrence of 31.50 ± 3.64 months. Noisy breathing was the commonest symptom (94.1%); history of atopic rhinitis in 64.7% of cases and hyperactive airway disease in 45.1% more than 50% of cases with airway narrowing resolved with medical management only.
CONCLUSION
Adenoid hypertrophy should be considered in evaluating the upper airway in children under five. Paediatricians should be conversant with diagnosing and managing this common cause of upper airway obstruction.
FUNDING
None declared.
Topics: Humans; Adenoids; Male; Female; Nigeria; Retrospective Studies; Hypertrophy; Child, Preschool; Child; Infant; Treatment Outcome; Radiography; Adenoidectomy; Ambulatory Care Facilities; Airway Obstruction
PubMed: 38957679
DOI: 10.4314/gmj.v57i3.7 -
Ghana Medical Journal Sep 2023To document the location, size, and multiplicity of intracranial aneurysms in Ghanaians who have undergone digital subtraction angiography (DSA) at a single centre in... (Observational Study)
Observational Study
OBJECTIVE
To document the location, size, and multiplicity of intracranial aneurysms in Ghanaians who have undergone digital subtraction angiography (DSA) at a single centre in Accra, Ghana.
DESIGN
We conducted a retrospective observational review of the medical records of all patients diagnosed with intracranial aneurysms on DSA.
SETTING
Patients' medical records at Euracare Advanced Diagnostic and Heart Centre were reviewed between March 2018 and March 2020.
PARTICIPANTS
Thirty-one patients were identified with various intracranial aneurysms (IAs) within the study period. Patients' ages, sex, and types of IAs were extracted using a checklist and analysed using Microsoft Excel for Windows 2016.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
The prevalence of types and distribution of intracranial aneurysms.
RESULTS
The age range of the patients was 26-76 years, with a mean age of 45.5±14.3 years. The mean age of men and women with IA was 45.5 ±15.9 years and 46.7 51.3±12.9 years, respectively. The most common IAs were located in the posterior communicating artery (PCOM) at 54.8% (95%CI: 36.0, 72.7), followed by the anterior communicating (ACOM), which constituted 32.3% (95%CI: 16.7, 51.4). The majority, 89.2% (33/37) of these aneurysms were less than 7mm in diameter. Single aneurysms were present in 25 (80.6%).
CONCLUSION
The most common IAs were found in the PCOM and ACOM, and IAs tend to rupture at a younger age and smaller size among the Ghanaian adults examined. Early detection and treatment of IAs less than 7mm in diameter is recommended.
FUNDING
None declared.
Topics: Humans; Intracranial Aneurysm; Ghana; Female; Male; Adult; Middle Aged; Retrospective Studies; Aged; Angiography, Digital Subtraction; Prevalence
PubMed: 38957670
DOI: 10.4314/gmj.v57i3.13 -
Radiology Case Reports Aug 2024Filling defects within the inferior vena cava (IVC) are common findings on computed tomography (CT); nevertheless, a majority of these defects are attributed to...
Filling defects within the inferior vena cava (IVC) are common findings on computed tomography (CT); nevertheless, a majority of these defects are attributed to artifacts. The documentation pertaining to pseudothrombosis specifically affecting the infrarenal vena cava is notably insufficient in current literature. The aim of this study is to present a case demonstrating a blood-contrast level in the infrarenal vena cava, resembling an intraluminal filling defect.
PubMed: 38957651
DOI: 10.1016/j.radcr.2024.05.053